Relationship between handgrip strength and self-reported functional difficulties among older Indian adults: The role of self-rated health

Association of handgrip strength weakness and asymmetry with cognitive impairment and depressive symptoms in older Chinese adults

This study investigated the association between handgrip strength (HGS) asymmetry and weakness with cognitive function and depressive symptoms among 920 community-dwelling adults aged above 60 years in suburban Shanghai. Participants were selected using a multistage cluster-stratified sampling approach. Assessments included HGS measured with a dynamometer, the Montreal Cognitive Assessment (MoCA) for cognition, and the Geriatric Depression Scale (GDS) for depressive symptoms. Restricted cubic splines revealed a positive association between dominant HGS and MoCA scores, indicating better cognitive performance, and a negative association with GDS scores, suggesting fewer depressive symptoms. The association between the HGS ratio and MoCA scores and the HGS ratio and GDS scores varied by sex. Women with HGS weakness alone (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17-3.37), asymmetry alone (OR = 1.93, 95% CI = 1.14-3.29), or weakness and asymmetry together (OR = 2.57, 95% CI = 1.48-4.46) had a significantly increased risk of cognitive impairment. However, no such associations observed in men. These findings suggest that HGS weakness and asymmetrical HGS may be associated with a higher risk of cognitive decline and depressive symptoms, particularly in women. This study emphasizes the need for sex-specific assessments and prevention strategies to address cognitive and mental health issues among older adults.

Longitudinal association between handgrip strength and depressive symptoms in middle-aged and older Chinese adults: mediating role of functional limitation

Background

The relationship between handgrip strength (HGS) at baseline and subsequent depressive symptoms among middle-aged and older Chinese adults remains highly uncertain. This research endeavored to investigate the effect of functional limitation on the association between these two variables.

Methods

A total of 5,684 participants aged ≥45 years from the China Longitudinal Study of Health and Retirement (CHARLS) were enrolled, using data from the 2015 and 2018 waves. Functional limitation was evaluated based on participants' self-reported basic activities of daily living (BADL) and instrumental activities of daily living (IADL). Logistic regression models were utilized to analyze the relationship between HGS and subsequent depressive symptoms, and bootstrap analysis was performed to explore the potential mediating role of functional limitation.

Results

After adjusting for confounders, an inverse correlation was detected between HGS and functional limitation (B = -0.885, p < 0.001), a positive correlation was found between functional limitation and subsequent depressive symptoms (B = 1.054, p < 0.001). The mediated effect size of HGS on depressive symptoms through functional limitation was a*b = -0.933 (BCa 95% CI: -1.224, -0.642). Functional limitation had a significant impact on 18.9% of the overall association.

Conclusion

Among the Chinese middle-aged and senior population, functional limitation accounted for 18.9% of the connection between HGS and depressive symptoms. Interventions targeting the enhancement of muscle strength should be regarded as crucial elements for maintaining physical function and preventing depressive symptoms.

Relative handgrip strength as a vitality measure in US stroke survivors

PURPOSE

Stroke is a leading cause of long-term disability in the US, yet a feasible assessment measure with predictive value for components of the International Classification of Functioning, Disability, and Health (ICF) Core Set for Stroke is lacking. The purpose of the present study was to explore the predictive value of potential assessment measures on factors within each ICF component in stroke survivors.

MATERIALS AND METHODS

Demographic, anthropometric, blood-based biomarker, physical functioning, and Global Physical Activity Questionnaire data were collected on stroke survivors in the 2011-2018 NHANES cycles. Potential predictors (handgrip strength relative to weight, age, sex, race, education level, marital status, poverty ratio, stroke chronicity) of physical function, activities of daily living (ADLs), participation in social activities, metabolic syndrome, and meeting physical activity recommendations were evaluated using weighted linear and ordinal logistic regression.

RESULTS

Relative handgrip strength was a significant predictor of physical function, difficulty participating in ADLs and social activities, and odds of meeting physical activity recommendations. As relative handgrip strength increased, these factors improved among stroke survivors.

CONCLUSIONS

To decrease disability rates and optimize function among stroke survivors, the use of assessment measures like relative handgrip strength that may predict multiple ICF components is warranted.

Unveiling the dynamics of social engagement and subjective health in older adults: A gendered perspective

OBJECTIVES

As populations age globally, understanding the dynamics that influence the well-being of older individuals become increasingly crucial. The research employs a comprehensive approach to unravel the multifaceted interplay between social engagements and subjective health perceptions of older Indians, with a special focus on gender differences.

SUBJECTS AND METHODS

This study used data from the Longitudinal Aging Study in India (LASI) wave 1, 2017-18 with a total sample of 30,533 older adults aged 60 years and above. Bivariate analysis, chi-square tests and unadjusted and adjusted average marginal effects from logistic regression models were used to assess the relationship between social engagements and subjective health among older adults, stratified by gender.

RESULTS

The prevalence of poor health status decreased with higher frequency of social networks among both men (pp. (percentage point) = 6.1; CI (Confidence Interval): 10.6, 1.6) and women (pp. = 9.2; CI: 14.9, 3.4). The adjusted average marginal effects demonstrate that with an increase in the overall score of social engagement, the likelihood of poor health is almost reduced by half. For men, the prevalence of poor health was 9.8 pp. (95 % CI: 13.7, 5.8), while for women, it was 9.3 pp. (95 % CI: 15.2, 3.1).

CONCLUSION

Gendered perspectives unveil unique patterns, highlighting how societal expectations and roles assigned to each gender may influence the subjective health perceptions of older individuals. This study adds to the expanding knowledge base to enhance the well-being and fulfillment of aging populations, considering the complex interplay of social dynamics and gendered perspectives.

The relationship between handgrip strength and cognitive function among older adults in China: Functional limitation plays a mediating role

BACKGROUND

The deterioration of cognitive function with age has become a major public health issue. To date, the underlying mechanisms of the association between handgrip strength and cognitive function were poorly understood. This study aimed to examine the mediating effect of functional limitation in the longitudinal relationship between handgrip strength and subsequent cognitive function.

METHODS

This research recruited 4416 participants aged 60 and above from wave 2015 and 2018 of the China Longitudinal Study of Health and Retirement (CHARLS). We conducted the linear regression model and bootstrap analyses to test the mediating role of functional limitation in the relationship between handgrip strength and cognitive function.

RESULTS

After adjusting the confounders, handgrip strength was positively associated with subsequent cognitive function (β = 0.12, P < 0.001) and was negatively associated with functional limitation (β = -0.14, P < 0.001). The mediation effect of functional limitation accounted for 23.33 % of the total effect regarding the handgrip strength with cognitive function, and the magnitude of mediation effect was a*b = 0.021 (95%CI: 0.017-0.027).

LIMITATIONS

The variable of functional limitations was self-reported. And this study did not analyse the severity and duration of handgrip strength loss and functional limitations, which may lose some information.

CONCLUSIONS

Our findings revealed that handgrip strength not only directly influenced cognitive function among older individuals but also indirectly via functional limitation over 3-year follow-up. Physical exercise targeting handgrip strength and functional limitation may be an effective approach to prevent and delay cognitive decline.

Examining factors contributing to the socioeconomic inequalities in handgrip strength among older adults in India: a decomposition analysis

The purpose of this study was to examine (a) the socioeconomic status (SES)-related inequalities associated with handgrip strength (HGS); and (b) the extent to which several demographic, health, and behavioral factors contributed to such SES disparities in HGS among older adults in India. Data were drawn from the 2017-2018 wave 1 of the Longitudinal Ageing Study of India (LASI). The study sample included 27,707 older adults (13,199 men and 14,508 women) aged 60 years and older. HGS was assessed using a handheld Smedley's Hand Dynamometer with a cut-off of 19.5 kg for men and 12.5 kg for women. Bivariate analysis showed the weighted percentage distribution of weak HGS across respondent characteristics. Multivariate logistic regression assessed factors linked to weak HGS. The concentration curve and index (CCI) was used to determine the inequalities in the prevalence of weak HGS by wealth index scores. Wagstaff's decomposition approach was used to test the contribution of each explanatory variable to weak HGS. Around 9% of older adults in this study reported a weak HGS. It was significantly higher among those aged 80 or older (19.21%) and males (15.55%). Weak HGS was concentrated among older adults from poor SES (CCI: 0.05, p < 0.001). A higher percentage of wealth-based inequality in weak HGS was explained by being underweight (38.83%), belonging to the richest wealth quintile (27.95%), and having a higher subjective social status (32.20%). Moreover, about 23.29% of the inequality in weak HGS was explained by Western region and 22.54% by female gender. Additionally, having a secondary level of education explained a higher percentage (22.09%) of inequality, followed by current working status (- 20.68%). Rural residence (13.08%), limitations in instrumental activities of daily living (IADL) (12.21%), and engagement in yoga-related activities (11.55%) explained a higher percentage of wealth-based inequalities. The findings provide evidence of significant SES-related inequalities in HGS and the contribution of various demographic, health, and behavioral factors to such inequality. As such, public health policies and programs focusing on reducing the burden of disability must consider the contribution of social and economic equity to the preservation of muscle strength among older adults.

Biological ageing and the risk of decreased handgrip strength among community-dwelling older adult Indians: a cross-sectional study

BACKGROUND

Evidence from the literature demonstrates that the risk of decreased handgrip strength is associated with various health issues, particularly in older persons. To make judgments regarding their general health condition that are well-informed for longevity, it is crucial to assess the risk level of decreased handgrip strength among community-dwelling older adult Indians. However, no study has examined the relationship between biological aging and the risk of decreased handgrip strength in Indian men and women aged 60 and older. The goal of the current study was to fill this gap in the literature.

METHODS

In this cross-sectional study, we included 31,464 (15,098 men and 16,366 women) community-dwelling older adult Indians aged 60 years and older using data from the Longitudinal Aging Study in India (LASI). The LASI is the world's most extensive and India's first multidisciplinary, internationally harmonized, longitudinal aging study. It has enrolled 72,250 individuals aged 45 and above across all 28 states and 8 union territories of India. Secondary analysis of biological ageing was performed by stratifying for age groups (60-64, 65-69, 70-74, 75-79, 80-84, and 85 + years) for both genders. The dominant right and nondominant left handgrip strength was assessed using the portable Smedley's Hand Dynamometer. All individuals had a dominant right hand. The adjusted logistic regression analysis assessed the association between biological ageing and the risk of decreased handgrip strength for both genders.

RESULTS

Compared to those between the ages of 60-64, those at age 65 and those aged 85 and above had 1-fold and 12-fold odds of decreasing handgrip strength, respectively. Men 85 years or older had a 12-fold higher chance than women in the same age group of having decreased handgrip strength.

CONCLUSIONS

The results indicate that community-dwelling older adult Indians aged 65 years and older are significantly associated with a higher risk of decreased handgrip strength, especially among older men. The results of this study can help assess and implement handgrip strength measurement in medicine for older Indians as part of regular admission assessment, particularly for older men.

Bidirectional association between handgrip strength and ADLs disability: a prospective cohort study

Background

Decreased handgrip strength (HGS) and activities of daily living (ADL) disability are common in aging populations. No studies have evaluated the bidirectional associations between HGS and ADL disability. This study aimed to explore the bidirectional effects of HGS and ADL disability.

Methods

This study analyzed data from two waves (2011 and 2015) of China Health and Retirement Longitudinal Study (CHARLS). Low HGS is defined by the Asian Working Group for Sarcopenia criteria. Meanwhile, disability was assessed by ADLs scale. The prospective bidirectional association between HGS and ADL disability was examined using binary logistic regression. Subgroup analysis were performed according to age and gender.

Results

A total of 4,902 and 5,243 participants were included in the Stage I and Stage II analyses, respectively. On the one hand, low HGS was significantly associated with subsequent ADL disability. The odds ratio (OR) value of developing BADL disability and IADL disability were 1.60 (95% confidence interval (CI): 1.23-2.08) and 1.40 (95% CI: 1.15-1.70), respectively, in participants with low HGS. On the other hand, baseline ADL disability was associated with an increased risk of developing low HGS. The OR value of developing low HGS were 1.84 (95% CI: 1.34-2.51) and 1.46 (95% CI: 1.19-1.79) for participants with BADL disability and participants with IADL disability, respectively. Lastly, the strength of the bidirectional associations varied among subgroups.

Conclusions

A significant bidirectional associations were identified between HGS and ADL disability. Interventions should be developed to prevent the development or progression of both low HGS and ADL disability.

Associations between intrinsic capacity, functional difficulty, and fall outcomes among older adults in India

The construct of intrinsic capacity (IC) in the context of integrated care for older adults emphasizes functional assessment from a holistic perspective. It provides reliable and comparable insights on subsequent functioning and disability. Given the paucity of research on IC and health outcomes in low- and middle-income countries (LMICs), the present study examined the association of IC with geriatric conditions of functional limitations and multiple fall outcomes among older adults in India. The data used for analysis come from the first wave of the Longitudinal Aging Study in India (LASI), 2017-2018. The final sample size contains 24,136 older adults (11,871 males and 12,265 females) age 60 years or above. Multivariable binary logistic regression is employed to examine the association of IC and other explanatory factors with outcome variables of difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL), falls, fall injury, and multiple falls. Of the total sample, 24.56% of older adults were observed to be in the high IC category. The prevalence of ADL difficulty, IADL difficulty, falls, multiple falls and fall-related injury is estimated to be 19.89%, 45.00%, 12.36%, 5.49% and 5.57%, respectively. Older adults who reported high IC had a significantly lower prevalence of ADL difficulty (12.26% vs 22.38%) and IADL difficulty (31.13% vs 49.52%) than those who reported low IC. Similarly, a lower prevalence of falls (9.42% vs 13.34%), fall-related injury (4.10% vs 6.06%) and multiple falls (3.46% vs 6.16%) were reported among those who had high IC. After adjusting for a large number of confounders such as age, sex, health-related attributes and lifestyle behaviors, older adults with high IC had significantly lower odds of ADL difficulty [aOR: 0.63, CI: 0.52-0.76], IADL difficulty [aOR: 0.71, CI: 0.60-0.83], falls [aOR: 0.80, CI: 0.67-0.96], multiple falls [aOR: 0.73, CI: 0.58-0.96] and fall-related injury [aOR: 0.78, CI: 0.61-0.99]. That a high IC was independently associated with a lower risk of functional difficulty and fall outcomes in later life is of enormous value in predicting subsequent functional care needs. More specifically, the findings here imply that because regular IC monitoring can predict poor health outcomes in older adults, improvements in IC should be prioritized while formulating disability and fall prevention strategies.

The association between loneliness and life satisfaction: examining spirituality, religiosity, and religious participation as moderators

BACKGROUND

Future cohort of older adults may have to rely on non-family sources and forms of support, religion being one of them. This may be especially so, considering the recent longitudinal evidence that individuals are inclined to become more religious with increasing age. Thus, the purpose of the present study was to assess the association between loneliness and life satisfaction among older adults in India, and the extent to which the association between loneliness and life satisfaction is moderated by spirituality, religiosity, and religious participation.

METHODS

Data come from the Longitudinal Ageing Study in India, with a sample of 31,464 individuals aged 60 years and above. Multivariable logistic regression models were employed to examine the independent association of loneliness and life satisfaction. Further, an interaction analysis was conducted to examine the extent to which the association between perceived loneliness and life satisfaction is moderated by spirituality, religiosity and religious participation among older Indians.

RESULTS

The prevalence of low life satisfaction (LLS) was 30.84%; a total of 37.25% of participants reported feeling lonely, 12.54% reported a lack of spiritual experience, 21.24% reported not being religious, and 19.31% reported not participating in religious activities. Older adults who felt lonely had higher odds of LLS relative to peers who were not lonely. Further, the adverse impact of loneliness on LLS among older Indians is moderated by their spirituality, religiosity, and religious participation. Specifically, the adverse impact of loneliness on LLS was less negatively pronounced among older adults who were spiritual, religious, and engaged in religious activities.

CONCLUSIONS

The study found an independent association between loneliness and lower life satisfaction among older adults in India. It also revealed that religiosity, spirituality and religious participation moderate the association between loneliness and lower life satisfaction. These findings, which underscore the health promoting benefits of religiosity and religious engagement, may be used to build on the interaction between religious and faith-based groups and public health professionals.

Socio-demographic and lifestyle factors associated with intrinsic capacity among older adults: evidence from India

BACKGROUND

Since the traditional models missed the possibility of formulating personalised programs centred on a person's priorities and values, it was a pressing priority to shift from traditional disease-centred to a function-based approach of healthy ageing, which is defined as 'the process of developing and maintaining the functional ability that enables well-being in older age'. The present study aimed to assess the prevalence of high intrinsic capacity (IC) of older adults and to examine the socio-demographic and lifestyle factors associated with IC among older adults in India.

METHODS

The study utilises the individual-level data from the first wave of the Longitudinal Aging Study in India (LASI) conducted during 2017-18. The total sample size for the present study was 24,136 older adults (11,871 males and 12,265 females) aged 60 years and above. Descriptive statistics, along with bivariate analysis, was employed to present the preliminary results. Additionally, multivariable linear and logistic regression analyses were conducted to find out the association of socio-demographic and lifestyle factors with IC and its components.

RESULTS

The mean IC score was found to be 7.37 (SD = 1.6) in this study. A proportion of 24.56% of older adults was observed to be in the higher IC category. Increasing age was negatively associated with high IC for older men and women. Older people who smoke tobacco (β = -0.23; CI: -0.32--0.13) and chew tobacco (β = -0.11; CI: -0.18--0.03) were less likely to experience high IC compared to their respective counterparts. Older adults who reported episodic alcohol drinking were less likely to have high IC (β = -0.20; CI:-0.32--0.07). The engagement in moderate physical activity (β = 0.12; CI:0.01-0.23), vigorous physical activity (β = 0.12; CI:0.05-0.20) and yoga-related activity (β = 0.18; CI:0.09-0.26) were significantly positively associated with high IC. Among the five domains of IC, education was significantly associated with higher capacity in each domain, and increasing age was found to be a significant predictor of lower capacity in each IC domain except locomotion. Older men and women engaged in vigorous physical activity had 35 and 19% significantly higher odds of high capacity in sensory (aOR = 1.35; CI: 1.12-1.62) and psychological (aOR = 1.19; CI: 1.06-1.34) domains, respectively.

CONCLUSIONS

The study revealed that lifestyle behaviours including tobacco use, episodic alcohol drinking and physical activity are strongly associated with IC among older adults in India. The findings suggest that healthy lifestyle behaviours should be encouraged among older adults as an effort to improve their IC, which is the key determinant of functional ability and quality of life in later years of life.

BMI mediates the association of family medical history with self-reported hypertension and diabetes among older adults: Evidence from baseline wave of the longitudinal aging study in India

Background

This study explored the association between family history of hypertension and diabetes with their diagnosis among older Indian adults. The study further examined the role of body mass index (BMI) as a potential mediator in these associations.

Methods

Data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1 were used. The sample for the study included 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis has been conducted to assess the prevalence of self-reported hypertension and diabetes. Further, multivariable logistic regression models were used to test the research hypotheses of this study. The Karlson-Holm-Breen (KHB) mediation analysis was conducted to recover the direct and indirect effects of BMI in the association of family medical history and diagnosis of hypertension and diabetes.

Results

A proportion of 32.70% of older adults were diagnosed with hypertension and 14.23% of older adults were diagnosed with diabetes. A proportion of 19.48% and 14.69% of older adults had a family history of hypertension and diabetes, respectively. Also, 16.57% and 5.53% of older adults were overweight and obese, respectively in the current study. Older adults who had family history of hypertension had higher odds of being diagnosed with hypertension [aOR: 2.23, CI: 2.07-2.39] than those who had no such family history. This association was mediated by BMI (percent mediated: 6.31%). Similarly, older adults who had family history of diabetes had higher odds of being diagnosed with diabetes [aOR: 2.63, CI: 2.41-2.88] than those who had no such family history. This association was mediated by BMI (percent effect mediated: 6.66%).

Conclusion

The study highlights the relevance of using family medical history data along with information on BMI as potential source for the control and management of hypertension and diabetes among older population.

Association of objective and subjective socioeconomic markers with cognitive impairment among older adults: cross-sectional evidence from a developing country

OBJECTIVE

This study explored how various markers of objective and subjective socioeconomic status (SES) are associated with cognitive impairment among older Indian adults.

DESIGN

A cross-sectional study was conducted using large nationally representative survey data.

SETTING AND PARTICIPANT

This study used data from the Longitudinal Ageing Study in India (2017-2018). The sample included 31 464 older adults aged 60 years and above.

PRIMARY AND SECONDARY OUTCOME MEASURES

Outcome variable was cognitive impairment, measured through broad domains of memory, orientation, arithmetic function, and visuo-spatial and constructive skills. We estimated descriptive statistics and presented cross-tabulations of the outcome. Χ2 test was used to evaluate the significance level of differences in cognitive impairment by subjective (ladder) and objective SES measures (monthly per-capita consumption expenditure (MPCE) quintile, education and caste status). Multivariable linear and logistic regression analyses were conducted to fulfil the objectives.

RESULTS

A proportion of 41.7% and 43.4% of older adults belonged to low subjective (ladder) and objective (MPCE) SES, respectively. Older adults with low subjective (adjusted OR (aOR): 2.04; p<0.05) and objective SES (aOR: 1.32; p<0.05) had higher odds of having cognitive impairment in comparison with their counterparts, with a stronger subjective SES-cognitive impairment association. Older adults with lower education or belonged to lower caste had higher odds of cognitive impairment than their counterparts. Interaction analyses revealed that older adults who belonged to lower subjective and objective (poorest MPCE quintile, Scheduled Castes and lowest education) SES had 2.45 (CI: 1.77 to 3.39), 4.56 (CI: 2.97 to 6.98) and 54.41 (CI: 7.61 to 388.93) higher odds of cognitive impairment than those from higher subjective and objective SES, respectively.

CONCLUSION

Subjective measures of SES were linked to cognitive outcomes, even more strongly than objective measures of SES; considering the relative ease of obtaining such measures, subjective SES measures are a promising target for future study on socioeconomic indicators of cognitive impairment.

Relationship between handgrip strength, depression and cognitive functioning among older adults: Evidence from longitudinal ageing study in India

BACKGROUND

Handgrip strength (HGS) is a frequent and general indicator of muscle strength and it may affect several aspects of mental health among older people. This study explored the association of HGS with depression and cognitive impairment among community-dwelling older adults in resource-constrained setting of India.

METHOD

Data were drawn from the Longitudinal Ageing Study in India (LASI), and the analysis was conducted on 27,707 older adults aged 60 years and above. Outcome measures included depression (assessed by the Short Form Composite International Diagnostic Interview (CIDI-SF) and the Center for Epidemiological Studies-Depression (CES-D) scales) and cognitive impairment. Descriptive statistics and mean scores of HGS were reported and multivariable linear regression analyses were conducted to test the research hypotheses of the study.

RESULTS

Mean score of HGS was 24.33 (SD: 7.22) for males and 15.94 (SD: 5.14) for females. Mean age was 68.86 (SD: 7.19) and 68.40 (SD: 7.31) years among males and females respectively. Older participants who had weak HGS were significantly more likely to be depressed in CIDI-SF scale (B: 0.06, CI: 0.01-0.13) and CES-D scale (B: 0.02, CI: 0.01-0.03) in comparison to those who had strong HGS after adjusting for a large number of confounders. Older participants who had weak HGS were significantly more likely (B: 0.92, CI: 0.76-1.07) to have cognitive impairment compared to those who had strong HGS.

CONCLUSION

The findings highlight the independent association of HGS with major depression, depressive symptoms and cognitive impairment that have implications on promoting resistance-training programs among aged population.